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New advances in the diagnosis of primary aldosteronism

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Chronic Diseases and Translational Medicine 2020年第1期6卷 1-5页

作者： Shen Hang Xu Zhi-Xin Li Qi-Fu Department of Endocrinology The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China

Primary aldosteronism (PA) is a common form of endocrine hypertension. The diagnostic process of PA includes a screening test, confirmatory test, and subtype classification. In this review, we have summarized the latest advances in the diagnosis of PA with regard to screening and confirmatory tests and provided some recommendations to improve clinical practice.

关键词： Primary aldosteronism Screening test Confirmatory test

Adrenal Venous Sampling in Patients with Primary aldosteronism: Which Is the Best Evaluation Method for Laterality Assessments?

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Open Journal of Radiology 2017年第4期7卷 219-227页

作者： Kimei Azama Masahiro Okada Akira Yogi Tomomi Koga Yuko Iraha Joichi Heianna Hideaki Nakamura Hiroaki Masuzaki Sadayuki Murayama Department of Radiology Graduate School of Medicine University of the Ryukyus Nishihara Japan Department of Radiology Nihon University School of Medicine Tokyo Japan Department of Radiology Nakagami Hospital Okinawa Japan Division of Endocrinology Diabetes and Metabolism Hematology and Rheumatology (Second Department of Internal Medicine) Graduate School of Medicine University of the Ryukyus Nishihara Japan

Purpose: The purpose was to investigate the most accurate method of adrenal venous sampling to diagnose unilateral primary aldosteronism (PA) prior to laterality assessment. Materials and Methods: Sixty-four consecutive PA patients were enrolled in this retrospective study. A catheter was placed in the common-trunk-vein (CTV), below the confluence of the inferior-phrenic-vein and the central-adrenal-vein (CAV) and the right-adrenal-vein (RAV). Blood-sampling was performed both pre- and post-adrenocorticotropic hormone stimulation. Lateralized ratio [LR;aldosterone/cortisol ratio (ACR) on high-value side/ACR on low-value side], contralateral ratio (CR;ACR on low-value side/ACR on inferior-vena-cava ratio), and plasma aldosterone concentration (PAC) were evaluated. The diagnostic accuracy of LR, CR and PAC in CTV/ CAV/RAV during pre- and post-ACTH was compared by receiver-operating-characteristic (ROC) analysis. Results: LR-CAV post-ACTH showed the highest detection rate for unilateral adrenal lesions (93.3%;14/15), with a sensitivity of 0.93 and a specificity of 0.84 at a cut-off value of 2.5. CR-post-ACTH had the highest Az value (0.89), with a detection rate of 86.7% (13/14), a sensitivity of 0.98, and a specificity of 0.88 at a cut-off value of 0.8. Conclusion: CR-post-ACTH and LR-CAV-post-ACTH are accurate predictors for laterality assessment in PA.

关键词： Adrenal Venous Sampling Primary aldosteronism Hypertension Adrenal Grand

Coexistence of the Hypersecretion of Catecholamine,Adrenal Cortical Nodular Hyperplasia,and Nephrotic-Range Proteinuria of Focal Segmental Scleronephrosis:Is It Fat-Induced Hypertension?

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International Journal of Clinical Medicine 2011年第3期2卷 206-211页

作者： Khanh vinh quoc Luong Lan Thi Hoang Nguyen Si van Nguyen Ninh T.Nguyen Vietnamese American Research Foundation WestminsterUSA Department of Pathology/Garden Grove Medical Center Garden GroveUSA Department of Surgery/UCI Medical Center OrangeUSA

Two patients had a long history of hypertension and one of them also had a nephrotic-range proteinuria secondary to focal segmental scleronephrosis which had been diagnosed by kidney biopsy. They presented with uncontrolled hypertension. Laboratory examination suggested hypersecretion of catecholamines by the left adrenal glands in both patients and primary aldosteronism in one of them. A computed tomography scan revealed small nodules on left adrenal gland in both patients. Patients underwent laparoscopic left adrenalectomy. After surgery, blood pressure was normalized and proteinuria was resolved. Most interestingly, prominent adipocytes infiltrated were detected in the adrenal cortex and were associated with the presence of lymphocytes, which suggested that adipocytes might have a role in the pathogenesis of these diseases in our patients.

关键词： Pheochromocytoma aldosteronism Adipocyte Nephrotic Syndrome Focal Segmental Scleronephrosis Adrenal Cortical Hyperplasia

Endocrine hypertension:An overview on the current etiopathogenesis and management options

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World Journal of Hypertension 2015年第2期5卷 14-27页

作者： Reena M Thomas Ewa Ruel Prapimporn Ch Shantavasinkul Leonor Corsino Division of Endocrinology Metabolism and NutritionDepartment of MedicineDuke University Medical Center Division of Nutrition and Biochemical Medicine Department of MedicineRamathibodi HospitalFaculty of MedicineMahidol University

Endocrine causes of secondary hypertension include primary aldosteronism,pheochromocytoma,cushing's syndrome,hyperparathyroidism and hypo-and *** comprise 5%-10% of the causes of secondary *** hyperaldosteronism,the most common of the endocrine cause of hypertension often presents with resistant or difficult to control hypertension associated with either normo-or ***,a great mimicker of many conditions,is associated with high morbidity and mortality if left untreated.A complete history including pertinent family history,physical examination along with a high index of suspicion with focused biochemical and radiological evaluation is important to diagnose and effectively treat these *** cost effective targeted genetic screening for current known mutations associated with pheochromocytoma are important for early diagnosis and management in family *** current review focuses on the most recent evidence regarding causes,clinical features,methods of diagnosis,and management of these conditions.A multidisciplinary approach involving internists,endocrinologists and surgeons is recommended in optimal management of these conditions.

关键词： Primary aldosteronism Hyperaldosteronism Adrenal Adenoma Pheochromocytoma

Aldosteronoma causing Conn’s syndrome: a case report and literature review

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Health 2009年第4期1卷 269-273页

作者： Hsin-Hui Shao Hock-Liew Eng Wen-Sheng Huang Joseph Nybo Lin 不详

We report a case of primary aldosteronism caused by bilateral solitary aldosteronomas occurring 6 months apart, the diagnosis being confirmed by clinical features. Multiple aldos-terone-producing adenomas can be unilateral or bilateral. If bilateral, most of them are found simultaneously. Bilateral solitary aldosterono-mas occurring at separate times are rarely re-ported and the pathogenesis is still elusive. We believe, from this case, the postoperative fol-low-up in patients with primary aldosteronism is mandatory.

关键词： Adrenal Tumor aldosteronism Bilateral Aldosterone-Producing Adenomas Aldosteronoma Adrenectomy